Historians believe that the practice of New Year resolutions originated in the Babylonian Kingdom, over 3,000 years ago. New Year intuitively brings time for pause, reflection and setting intentions for the year, and for many, that can centre on resetting what they eat, especially after indulging over the holidays.

In their annual round-up of the more bizarre fad diets for 2019, the BDA have suggested that the blood type diet, drinking your own pee (yes, really), detox teas/skinny coffee, slimming sachets and alkaline water, are some of the more bizarre regimes they’re coming up against.

Here’s a look at what else is hot in the wellness space, with some links to relevant, recent research that may help you in your daily communications or practice.

Lasting fasting

One thing that has remained popular as we come into the New Year, has been the idea of fasting and this month, Jurassic World actor Chris Pratt, announced to his 22.2 million followers that he’s doing the Daniel Fast.

If you haven’t heard of it, the Daniel Fast was created over a decade ago by Susan Gregory, according to the website, a ‘lay minister, businesswoman, coach for Christian living and wannabe techie’ and is a 21-day period of prayer and partial fasting practised by some Christians, based on the experience of the Prophet Daniel’s and Jewish fasting principles. According to the website, the permitted foods centre around vegan options, with some additional restrictions including all sweeteners (non-nutritive and nutritive), processed foods and solid fats.

Elsewhere and currently number 2 on Amazon.co.uk’s bestseller list for diet books, is Michael Mosley’s ‘The Fast 800’ (in fact it appears twice in the top-10 as a hardback and paperback). His latest offering since the popular 5:2 diet and 8-week Blood Sugar Diet (also still in the top-20), which centres on intermittent fasting/‘time-restricted eating’, is a low-carb, Mediterranean-style diet, based on only 800 calories.

For some recent papers on intermittent fasting in the past year, see the following links:

Also vying for the top spot of popular diets in 2019 is the Ketogenic Diet. A quick check of Google search trends shows that after bubbling away for the past few years, interest in this diet is starting to soar and it was the most searched diet term in 2018:

Being low-carb, high fat, the ‘traditional’ Keto Diet may jar against principles of plant-based eating, with new research in The Lancet reaffirming the importance of fibre (from vegetables and wholegrains) in the diet. Keto fans looking for a vegan or vegetarian version of the diet may instead opt for the plant-based version; dubbed ketotarianism, reminiscent of the pegan (paleo-vegan) that was also popular in 2018.

For some helpful papers on ketogenic diets published in the past year, see the following links:

The Times has also just published an interesting article (which is unfortunately behind a paywall) which to sum up, provides (rather alarming) insight into what’s on the cards for ‘wellness revolutionaries’ in 2019; citing pink coconut water, quartz crystals, salt lamps, MCT oil, edible coffee bars and tongue-scraping, amongst other endeavours, all seemingly in the pursuit of health.

On the other hand, continuing to get good traction is the interest in digestive health and the microbiome, and plant-based eating, with Pinterest’s list of 100 emerging trends for 2019, reporting that searches for oat milk increased in popularity by 186% last year.

It is probably unfair to drop all these increasingly popular approaches into a fad bucket. Some, such as intermittent fasting, have a promising and growing evidence to their name and others may have snippets of beneficial principles in them, such as being plant-based, Mediterranean-style eating or with a focus on minimally processed foods.

Others, however, lack any credibly with regards to the claims they are making; often having inflated what is otherwise an incomplete evidence-base or simply just making things up.

In this era of ‘nutrition folk wisdom’, now more than ever is expertise needed from qualified dietitians and nutrition professionals to make sense of what is becoming an increasingly confusing dietary minefield.

Are there other trends that other dietitians or registered nutritionists do find helpful? Do let us know your thoughts. Or if you are a company and an organisation planning what trends you should support we are always happy to discuss and advise. Call us for a hello on 020 8455 2126 or email hello@nutrilicious.co.uk

We thought that with the new year comes a great opportunity to take stock and consider what’s lined up for food, nutrition and public health in 2019.

Brexit: Politics and our plates

By far and away, the biggest thing in our diaries for 2019 will be Brexit and what will inevitably mark a fundamental change to the British food system as we’ve come to know it. Come 29 March, the deal will be done (or not!) and what that will look like is anybody’s guess right now.

The UK does not feed itself. We rely heavily on other countries for our food supply, with only 49 per cent of the food consumed in the UK produced here and 30 per cent coming from the EU; the equivalent to 10,000 shipping containers each day. For some commodities such as fruits and vegetables, our dependence on imports is much higher, in this case, we import 90 per cent of the fruits and vegetables we consume.

And so, because our food system is complexly intertwined with the EU, once we leave, it will significantly change our trading relationships, both with the EU, as well as those countries out of the EU that have trading agreements with it.

Consequently, people’s diets will be most likely be affected, with a working paper from the Oxford Martin School on the Future of Food warning that food prices are likely to increase, particularly for fruit and vegetables. According to this modelling, a Hard Brexit (trading on World Trade Organisation terms which imposes tariffs on imports) could lead to 5,600 additional deaths per year, associated with reduced consumption of fruits, vegetables, and nuts. This will not only affect individuals but the wider costs to society are pegged at increased healthcare expenditure at around 600 million GBP. On a positive note, there may be small benefits on obesity rates and reduced red meat consumption (see Figure 1)!

Figure 1. Changes in mortality in the UK by risk factor and cause of deaths under a Hard Brexit

EAT-Lancet Commission report

We’re expecting that the EAT-Lancet Commission report on Food, Planet, Health, due to launch on 17 January, is going to make waves. Never has the connection between food, planetary and human health been more apparent, with the need to address issues and impacts ever more pressing.

Housed at the Stockholm Resilience Centre, the EAT-Lancet Commission partnership brings together leading global researchers into five working groups, investigating:

What is a healthy diet?

What is a sustainable food system?

What are the trends shaping diets today?

Can we achieve healthy diets from sustainable food systems? How?

What are the solutions and policies we can apply?

The report will include the latest research on each of these workstreams and will be publishing targets that deliver for both people and the planet.

If you want to understand more about sustainable diets and how these new targets apply to your business, or would like a scientific review completed on another hot topic, please get in touch on 020 8455 2126.

Coming down the line from government

It looks like the team at Public Health England have been busy. While the rest of us were enjoying our mince pies, they have been working hard behind the sciences and they have kicked off the new year with the launch of new Change4Life messaging, raising awareness of the fact that on average, children are consuming their childhood sugar requirements by 10-years old.

But what else is on the agenda for the year ahead? With the updated Childhood Obesity Strategy published mid-2018 came promises of consultations on bans on pricing and positional promotions in retailers and a 9pm watershed for advertising of unhealthy food and drinks. Though we did see consultations conducted on the ban of sale of energy drinks to children and mandating calorie labelling in the out-of-home sector, some of the other consultations have not materialised yet, but they will be coming this year.

North of the border, the Scottish government also just completed their consultation on restricting junk food promotions, so it will be interesting to see what emerges there.

In 2018, SACN also consulted on their draft review of saturated fats, which recommended a continuation of previous COMA recommendations of 10% total calories. The final report is due at some point 2019 and is on the agenda for discussion at the next SACN meeting in March.

With saturated fat such a hot topic and matter of debate, keep your eyes peeled for this one, as it will provide some much-needed clarity and authoritative recommendations.

In addition, according to SACN meeting notes, the following items should also be expected in 2019:

Whole Systems Obesity Programme: a joint initiative of PHE, the Local Government Association and the Association of Directors of Public Health are due to publish their guide and tools in the spring

Product ranges targeted at babies and young children: scope and ambition for this programme is due mid-2019, following initial scoping and consultation that has already been conducted with industry and other stakeholders

School Food Standards: technical update to commence in 2019

National Diet and Nutrition Survey Year 1-9 Report: due imminently

So, that’s a brief flavour of some of the key things coming up on 2019. As ever, there’s lots of things to keep us busy!

Here at Nutrilicious we can help with your nutrition and health strategy, nutritional assessments of product portfolios, insights – views from the outside world of nutrition influencers and what they think of your offering – overall helping to put you on the front foot of your competition and upcoming government reformulation targets or standards. Or, perhaps you have key messages that you’d like to share with stakeholders through engaging new media such as interactive webinars and podcasts. To discuss your policy and communication requirements, you can reach us on 020 8455 2126.

As Hippocrates, the father of modern medicine, said more than 2,000 years ago, ‘All disease begins in the gut’. And modern science is proving it as true today as it was then.

In this blog we outline the importance of gut microbiota and the use of diet to affect them to try to improve health and welfare.

For a detailed exploration of the topic, register for our free, CPD-accredited NutriWebinar. Led by experts Professor Glenn Gibson and Laura Tilt, it will give you both incredible insight into the science and practical tips on how to help balance gut microbiota for real health benefits.

The importance of the gut microbiome

We have more than 1,000 species of bacteria in our gut. And there’s been an increasing realisation among scientists that these can have a profound effect on our health – from Irritable Bowel Syndrome to infections, asthma and inflammatory disease right through to bone health and cognitive function.

This understanding has led researchers to investigate what we can do to affect the microbiota, to be applied to this wide range of health problems. A steady stream of scientific publications over the last 15 years address the topic, alongside research into probiotics and, more recently, prebiotics – which selectively fertilise the ‘good’ bacteria.

Our gut microbiome status changes throughout our lives. We acquire our gut bacteria mostly at birth. Moving through the milk years, there are differences in acquiring bacteria between breast-fed and infant formulae fed babies: human milk.

There is change again at the weaning stage, after which the gut microbiota remains fairly stable. As we get older there is then a decrease in the largely in beneficial bacteria like the bifidobacteria.

The gut microbiota can be susceptible to various challenges: stress, infection, antibiotics and poor diet all amongst the factor coming into play on a daily basis.

How does diet affect our gut microbiome and our health?

Carbohydrates, proteins, amino acids and lipids are all metabolised by microbiomes in different ways, with different outcomes for our health.

Carbohydratemetabolism – especially that of fibre – leads to organic acids, short chain fatty acids, that have shown to be beneficial in the gut. For example:

Acetate is metabolised by the muscle, kidney, heart and brain

Propionate, cleared by the liver, is an appetite regulator also said to be involved in cholesterol synthesis

Butyrate is a fuel and regulates cell growth

Fibre itself can stimulate the growth of good bacteria. It’s been estimated that per 100g fibre fermented, 30g of bacteria is produced.

Metabolism of excess protein, on the other hand, leads to less positive end products:

Ammonia induces quick cell turnover

Phenols/indoles may act as co-carcinogens

Amines are linked to migraine, cancer, schizophrenia

Balancing our gut microbiota

Increased fibre intake

To help ensure balanced gut microbiota, our diet needs to include enough fibre. As discussed in our recent blog, government recommendations advise 30g per day for adults, representing a 60% increase in intake for most. Laura Tilt provides excellent advice on how this can be achieved in the NutriWebinar.

Probiotic and prebiotics

Much work has been done into probiotic supplements: live ‘good’ bacteria that bring health benefits, especially lactobacilli and bifido bacteria.

More recently, scientists have found that prebiotics could have an even more profound effect on our health. They work by selectively proliferating beneficial bacteria, which in turn inhibit pathogens. They may also have a more general effect, including dampening inflammatory issues.

Prebiotics are found naturally in human breast milk and in fructans and inulins in vegetables including asparagus, onion, banana and leeks. They can also be taken as supplements, especially in GOS forms.

Takeaway message

As our understanding of the link between gut microbiota and our health has grown, researchers have increasingly looked to see where we can have the most impact.

We’re in a position where health and nutrition professionals can advise clients on what they can do to improve their gut health and therefore overall wellbeing. We look forward to our research widening and deepening further to improve our understanding in this vital area.

Get involved in the discussion on social media: @Nutrilicious @NutriWebinar #lifelonglearning #feedingthegut

The most recent government guidelines on fibre intake recommend 30g per day for adults. Levels are currently at just 20g per day for adult men and 17.1g per day for women – that’s an average 68% increase in intake needed to meet recommendations.

And it’s not just adults: there’s a significant disparity between recommended and actual fibre intake across all age groups.

So why is fibre so important? And what can we do to help people meet the recommended intake levels?

Here’s a quick overview. To explore the topic in more detail, join our upcoming Fibre NutriWebinar, on Wednesday 7 November.

The benefits of fibre

Dietary fibre has long been recognised for its health benefits. But it’s only in recent years that our understanding and appreciation of it has significantly progressed.

Fibre’s health effects mainly result from two key factors – its physical properties (eg stool bulking, viscosity, binding ability) and its effect on the gut microbiota and luminal environment.

Amongst its many beneficial properties, clinical trials have proven that fibre:

Where are we getting our fibre from?

The main sources of fibre in the UK are cereals, vegetable and potatoes, contributing to 70% of total intake.

Interestingly, white bread and potato products prepared with fat (eg chips and crisps) are significant contributors. This is despite the fact that they have comparatively low fibre content, showing that consumption is high.

One of our challenges is to educate the public on healthier fibre sources – fruit, vegetables, whole grains and pulses, rather than broad recommendations on increasing cereals.

Understanding and helping consumers

We know that despite the convincing body of evidence for the role of dietary fibre in many chronic conditions, translating and achieving fibre recommendations in practice can be challenging.

Understanding the key barriers faced by the public and putting forward strategies to overcome these is key to facilitating better health for all.

The government recently announced new measures to halve rates of childhood obesity by 2030 and significantly reduce the health inequalities that persist – closing the gap in obesity rates between children from the most and least deprived areas.

This proposal builds upon the first chapter of the Childhood Obesity Plan, which was widely criticised at the time as lacking the breadth and depth of initiatives needed to effectively tackle such a widespread and entrenched issue.

Steve Brine, Public Health Minister has stated: “One in three children are now overweight or obese by the time they leave primary school. Overconsumption, combined with reduced activity, is having a catastrophic effect on our children’s health. As both a parent and minister, I am committed to driving today’s pledge of halving obesity over the next 12 years with bold new action.”

“Our updated plan will put parents in charge, providing more information and support. Our aim is to help families make healthier choices, which will in turn provide a better chance at a longer, healthier life for our children.”

Obesity – A systems issue

The financial burden of obesity is too great to ignore: it’s estimated that the NHS in England spent £6.1 billion on overweight and obesity-related ill-health in 2017/18, which, to put into context is more than was spent on the police, fire service and judicial system combined. The wider costs to society of these conditions are around £27 billion a year, if not higher.

Ever since the Foresight report was published over a decade ago, it has been recognised that obesity is a systems issue and one that therefore requires reform at many points, to deliver change. This idea and the fact that no plan to date has sought to address childhood obesity in a multi-sector way, was reiterated in the recent inquiry by the parliamentary Health and Social Care Committee into childhood obesity. Childhood Obesity: Time for Action argued for a change in narrative, making clear that obesity is everyone’s business and “an effective childhood obesity plan demands a holistic, joined-up, ‘whole systems’ approach with clear and effective leadership”.

How does the Childhood Obesity Strategy measure up?

This update to the Childhood Obesity Strategy is a welcome step forward. It contains a raft of proposed measures that seek to tackle the issue using a co-ordinated range of policy levers. What is also good to see is that this new plan takes a firm but fair approach in how it will deliver change: using voluntary measures in the first instance but being clear that a harder tact with the likes of regulatory and fiscal measures will be considered where progress is deemed insufficient, or where a level playing field is required.

Here at Nutrilicious, we’ve taken a closer look at what’s in store and benchmarked the new childhood obesity plan against the World Cancer Research Fund’s NOURISHING framework, as well as the recommendations from the Health and Social Care Committee’s report mentioned earlier.

The NOURISHING framework

The NOURISHING Framework sets out that policies are needed within three core areas to improve diets: the food environment, food system and behaviour change communication.

N – Nutrition label standards and regulations on the use of claims and implied claims on food
O – Offer healthy food and set standards in public institutions and other specific settings
U – Use economic tools to address food affordability and purchase incentives
R – Restrict food advertising and other forms of commercial promotion
I – Improve nutritional quality of the whole food supply
S – Set incentives and rules to create a healthy retail and food service environment
H – Harness food supply chain and actions across sectors to ensure coherence with health
I – Inform people about food and nutrition through public awareness
N – Nutrition advice and counselling in health care settings
G – Give nutrition education and skills

Bearing in mind that some policies and actions targeting childhood obesity were in place prior to this strategy update, overlaying the new measures show how broad their impact alone intends to be:

New measures

N

O

U

R

I

S

H

I

N

G

Nutrilicious notes

Improved food labelling to display ‘world-leading, simple nutritional information’ as well as information on origin and welfare standards following Brexit

X

Strengthen School Food Standards to reduce sugar consumption

X

X

We would like to see these universally applied and close the loophole that exists for some academies

Strengthen Government Buying Standards for Food and Catering Services*

X

X

Ban price promotions such as buy one get one free, multibuys or unlimited refills of unhealthy foods and drinks in the retail and out of home sector*

X

It is good to see a mandatory approach applied here, as this is what is undoubtedly needed when policies will impact businesses’ bottom line.

Ban the sale of energy drinks to children*

X

Ban promotion of unhealthy food and drink by location e.g. positioning – checkouts, end of aisles and store entrances, in retail and out of home sector*

X

Introduce a 9pm watershed on unhealthy food and drink advertising and similar protection online*

Introduce mandatory calorie labelling for out of home sector in England*

X

X

Sugar reduction plan for products aimed exclusively at babies and young children due in 2019*

X

Calorie reduction plan due mid-2019*

X

Develop trailblazer programme with local authority partners to highlight what can be done within existing powers

X

We would like to see greater powers for local authorities and health services

Develop plan to use Healthy Start vouchers to provide additional support to children from lower income families*

X

Ofsted will review school curriculum to understand how it can better support healthy behaviours, including food choices

X

X

We would like to see improved early years education for parents to support a healthy first 1000 days and compulsory home economics with healthy cooking skills at the core in both primary and secondary schools

*Proposal for further consultation

Is it enough?

While we applaud this latest round of the childhood obesity plan, we would also draw attention to the fact that there is still some way to go.

By mapping the proposed policy options against the NOURISHING framework, we can see that in this latest iteration of the plan much more focus has been given to shaping an environment that enables and supports healthier choices, which is great to see.

However, what is noticeably absent is the ‘I’ in terms of improving food and health literacy of the population. In a ‘post truth’ world where consumers are increasingly sceptical of messages coming from the scientific community, and when social media influencers are capturing the hearts and minds of the masses with questionable dietary advice, never has it been more important to provide clear, simple and authoritative information and advice. As such, we’d like to the see the government step-up their efforts on social marketing and educational campaigns.

What is more, a number of recommendations made in the Health and Social Care Committee are notably absent, including:

Establishing a Cabinet-level committee to review the implementation of the plan, ensuring it gets the high-level traction it requires

Proposing further measures around early years and the first 1,000 days of life, including targets to improve rates of breastfeeding

Banning the advertising and promotion of follow-on formula milk

Providing local authorities with further powers to limit unhealthy food and drink advertising near schools (the only powers available to local authorities extend to the positioning of the billboards themselves, not the content of the advertising)

Introducing services for children living with obesity

Finally, while this plan is overtly focussed on limiting unhealthy foods and drinks and making processed, packaged foods a little better through reformulation (lower in salt etc), we would also like to see equal attention given to measures that work improve the quantity and quality of foods that we do want people to eat more of. Changing the dietary landscape will require strong efforts to provide families with the tools and knowledge to instil these healthier behaviours in a sustainable way.

The final ‘Feeding in the First Year of Life’ report published by the Scientific Advisory Committee on Nutrition (SACN) supports current government recommendationsincluding breast is best, introduction of allergenic foods from six months and the importance of variety and textures.

Covering infant feeding from birth to 12 months, it provides its recommendations to government based on the best available evidence for the short- and long-term health outcomes for infants and mothers.

The one note of significant difference to existing advice is the recommendation that vitamin A supplements for infants should be discontinued. This will cause some inconvenience as most infant vitamin drops, which were developed on government advice, include vitamin A.

What is the SACN recommending to government?

More strategies and support to help mums breast feed exclusively for the first six months of the infant’s life and to continue breast feeding alongside weaning for the first year.

Where breast feeding is not possible, infant formulae based on either cows’ or the more recent goats’ milk are the only suitable alternative options. Soya-based formulae should only be introduced under medical advice.

Only breast milk, formula or water as a drink should be offered between six and 12 months.

Solids should be introduced from aroundsix months of age, ‘having achieved developmental readiness’. The SACN found no evidence for the critical window of opportunity (four-six months) for increased acceptance of solids.

Reducing risk of ‘fussy eaters’. Based on the evidence available, it is recommended that perseverance with repeated exposure of a variety of textures and flavours should be encouraged.

Introduction of textures is critical for the development of munching and chewing. Textures should be introduced incrementally depending on the infant’s individual development rate.

Baby-led weaning: due to too few studies, the SACN could not make any recommendations. However, it did make the point that the limited evidence to date is promising for earlier self-feeding and less food fussiness.

All allergenic foods should be introduced from six months in small quantities and one at a time. This is of course for infants not at high risk of or diagnosed with an allergy. It is particularly important for peanuts and hen’s eggs, where the evidence is strong that delayed introduction increases the risk of allergy later in life. Additionally, nuts such as peanuts should not be given whole until the age of five years to prevent choking risk.

Vitamin D intakes remain a concern for infants who are being breast fed or on less than 500ml formula daily. The SACN acknowledges the poor update of vitamin drops for babies but continues to emphasise the importance of encouraging breast feeding mums to use vitamin D supplements from birth.

Iron continues to be an issue beyond six months of age and greater emphasis should be placed on the introduction of iron rich foods, rather than supplements, from the start of weaning.

Vitamin A supplementation should no longer be encouraged as risk of deficiency is low and advises the government to review its current baby vitamin drop recommendations.

Energy intakes remain too high and infant weights exceed standard weight charts. There is a need to better monitor overweight and obesity in infants.

Salt and sugars intakes remain high in infants, with commercial baby foods, especially fruit purees, being the main contributors.

Throughout the report, the SACN make no distinction in their advice between commercial or home-made complementary foods – could this be a sign that reality and practicality has been taken into consideration?

The Public Health England (PHE) sugar reduction programme for complementary foods will be far more controversial than the new SACN recommendations.

We have heard this week that PHE have just finished their scoping work for their sugar reduction programme of complementary foods for infants and are preparing for discussions with industry, NGOs and other interested parties.

Setting sugar reduction targets for this category will be challenging, to say the least.

The complementary foods’ regulation, which PHE cannot over-ride, permits significantly high levels of sugars: up to 20g total sugars per 100g for ‘fruit only’ products and up to 25g per 100g for desserts and puddings.

There are huge discrepancies between PHE’s classification of ‘free sugars’ and regulatory and labelling classifications of ‘added sugars’. Sugars naturally present in fruit and vegetable purees are classified as ‘free sugars’ by PHE but not as ‘added sugars’ by foods or labelling regulations.

Some will argue that pureed formats of fruit and vegetable are essential as first foods, especially by those from the ever-exploding pouch market, and as such should be excluded from the ‘free sugars’ classification. However, there should be a strong opposition from health experts and very active pressure groups:

There is a growing consensus that fruit and sweet tastes should no longer be recommended as first foods in order to reduce the infants’ continued preference for sweetness.

Additionally, with the SACN’s affirmation that complementary feeding should start around six months, purees are no longer essential. At that age the infant is ready, and should be encouraged, to develop their munching and chewing skills which means the need for textures. Pureed food on the other hand only rely on an infant’s innate skills of sucking and swallowing.

Interesting times…let’s wait and see.

Complementary foods regulation update – will this rock the boat?

The updated version of the 2006 regulation on processed cereal-based foods and baby foods for infants and young children has yet to be published. The revised regulation was rejected last year for numerous reasons, including pesticide and sugar upper limits being too high.

The next version should be with us this year and it will be interesting to see how it aligns with the SACN’s and PHE’s recommendations – especially with regard to sugars and when solid foods should be introduced. Currently, the regulation (and the failed 2017 revision) permitted solid food introduction from four months.

So we’re pleased that this new SACN report helps to give support for the current advice in the UK: babies should ideally be exclusively breastfed for six months, and solid foods should be introduced after this. Or, as Dr Alison Tedstone, Chief Nutritionist at Public Health England (PHE) put it: “SACN’s robust advice puts to bed any arguments about a beneficial effect of early introduction of solid foods.”

We do however notice the very precise wording of ‘around six months’.

There is some concern amongst dietetic paediatric experts that setting a specific time for solid food introduction is unrealistic, may place some infants at risk and is an added pressure for mums on top of guilt faced by those who do not wish to or cannot breast feed.

The important factor is that solid foods should only be introduced when an infant is developmentally ready: when they can sit with minimal support and hold their head steady; can co-ordinate eyes, hands and mouth; and are able to reach out to pick up food and bring it to their mouth. Some infants may be ready before six months; a few may not be ready yet at that stage.

It’s important government advice should ensure mums understand that there is flexibility ‘around’ the six months.

Further advice on early feeding and breastfeedingIn the UK we have some of the lowest breastfeeding rates in the world, so it is important to provide help and support to mothers wishing to breastfeed. The NHS gives information about where to get help.